Analysis Of Characteristics And Risk Factors For CRE Infection/Colonization In A General Hospital’s PICU

Objective: To study the characteristics and risk factors for infection/colonization and nosocomial infection of carbapenem-resistant Enterobacteriaceae(CRE)in pediatric intensive care unit(PICU),and provide a guidance for prevention the nosocomial CRE infection in PICU.Methods: 1.Clinical data of patients with CRE,who were treated in PICU of the first hospital of Lanzhou University from March 2013 to April 2018,were collected.2.Clinical data of patients with carbapenem-sensitive Enterobacteriaceae(CSE),who were treated in this hospital’s PICU at the same period,were collected.3.According to the age,patients were divided into neonatal group and non-neonatal group.In each group,patients with CRE was defined as CRE group,and patients with CSE was defined as CSE group.To study the risk factors for CRE infection/colonization,the clinical data of neonatal group and non-neonatal group were analyzed retrospectively.4.The patients with CRE were divided into nosocomial-infection group and non-nosocomial-infection group.To study the risk factors of nosocomial CRE infection in PICU,the clinical data were analyzed retrospectively.Results: 1.Overall situation: In neonatal group,specimen types of CRE mainly include respiratory tract specimen(69.0%),blood flow system specimen(21.4%)and skin specimen(7.1%),and strains of CRE mainly are Klebsiella pneumoniae(55.8).%),Enterobacter cloacae(30.2%)and Escherichia coli(7.0%).In non-neonatal group,specimen types of CRE are all respiratory tract specimen(100%),and the strain of CRE mainly are Klebsiella pneumoniae(71.8%),Enterobacter cloacae(20.5%)and Escherichia coli(5.1%).In nosocomial infection group,the specimen types of CRE include respiratory tract specimen(70.0%),blood flow system specimen(25.0%)and urinary system specimen(5.0%),and the strain of CRE are Klebsiella pneumoniae(65.0%)and Enterobacter cloacae(35.0%).2.Multivariate analysis of positive variables in univariate analysis:the variables of neonatal group have no statistical significance.Duration of using ventilator before CRE was detected(P =0.015)is an independent risk factor for CRE infection/colonization of non-neonatal group and theduration of using β-lactamase inhibitor combination preparation(P = 0.040)is an independent protective factor that could reduce the rate of CRE infection/colonization.Duration of using cephalosporin(P = 0.048)and the hospital stay in PICU(P = 0.046)are independent risk factors for nosocomial infection of CRE.3.Prognosis and outcomes: There are no statistical differences in prognosis between CRE group and CSE group of neonatal group as well as non-neonatal group(P>0.05).There are no statistical differences in the rate of abandonment treatment and mortality between the nosocomial infection group and the non-nosocomial-infection group(P>0.05).In the rate of getting better,non-nosocomial-infection group are significantly higher than nosocomial-infection group(P=0.029).There is no statistical differences in antibiotic treatment between patients whose review results are negative and persistent positive of neonatal group and non-neonatal group as well as nosocomial-infection group(P>0.05).4.Hospitalization expenses and hospitalization days: As for hospitalization expenses and hospitalization days,CRE groups are significantly higher than CSE group both in neonatal group and not-neonatal group(P<0.05),and nosocomial-infection group are significantly higher than non-nosocomial-infection group(P <0.001).Conclusion: In PICU,the most common type of specimens for CRE infection/colonization is respiratory tract specimen,and the most common type of strain is Klebsiella pneumoniae.In non-neonatal group,using ventilator time before CRE was detected is an independent risk factor for CRE infection/colonization.Duration of using cephalosporin and hospital stay in PICU are independent risk factors for nosocomial infection of CRE.CRE infection/colonization can increase hospitalization expenses and prolong hospitalization days,and nosocomial CRE infection can significantly affect the rate of getting better.